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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset)
New
116
2
0
Form and Instruction
NA
ASQ Intake Questionnaire (Chinese - Subset)
Form and Instruction
NA
ASQ Intake Questionnaire (Korean - Subset)
Form and Instruction
NA
ASQ Intake Questionnaire (Vietnamese - Subset)
Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese)
New
803
134
0
Form and Instruction
NA
NQDW Intake Questionnaire - Chinese Complete
Form and Instruction
NA
NQDW Intake Questionnaire - Korean Complete
Form and Instruction
NA
NQDW Intake Questionnaire - Vietnamese Complete
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire
New
659
77
0
Form and Instruction
NA
NQDW 7-Month Follow-Up Questionnaire - English
Form and Instruction
NA
NQDW 7-Month Follow-Up Questionnaire - Chinese
Form and Instruction
NA
NQDW 7-Month Follow-Up Questionnaire - Korean
Form and Instruction
NA
NQDW 7-Month Follow-Up Questionnaire - Vietnamese
Follow-up for Callers who Received a Quitline Service
Removed
0
0
0
Form and Instruction
F1
NQDW 7-Month Follow-Up Questionnaire
NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves
Modified
478638
79773
0
Form and Instruction
NA
NQDW Intake Questionnaire - Complete
NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone else
Modified
26007
434
0
Form and Instruction
NA
NQDW Intake Questionnaire - Subset
NQDW Quitline Services Survey
Modified
216
72
0
Form and Instruction
NA
National Quitline Data Warehouse (NQDW) Quitline Services Survey
Submission of NQDW ASQ Seven-Month Follow-Up Electronic Data File to CDC
New
1
1
0
Instruction
Submission of NQDW Intake Questionnaire Electronic Data File to CDC
Modified
216
216
0
Instruction
Total burden requested under this ICR:
506656
80709
0
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